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Disordered eating can be defined operationally as any eating
behavior, or food or body image obsession, that negatively affects
health, work, or relationships. This may include restrictive dieting
or fasting, abuse of laxatives or appetite suppressants including
caffeine and nicotine, skipping meals or avoiding meals with family
and friends, overuse of meal supplements, excessive exercising (“exercise
bulimia”), chewing then spitting out food, or infrequent
binging or purging. Adolescents obsessed with body image may endanger
themselves by abusing bodybuilding supplements and performance-enhancing
drugs, including steroids, or may relentlessly pursue cosmetic surgery,
including liposuction. Disordered eating also includes unsafe dieting
techniques such as severe caloric restriction and “zero-carb” diets.
Disordered eating is often not recognized because the person suffering
may not look ill and does not consider his or her behavior as rising
to the level of an eating disorder. In fact, both overweight and
athletic youth are most at risk for developing disordered eating.
Children with disordered eating may engage in dieting or fasting
that seems unnecessary, avoid eating and eating situations, secretly
binge, or make overly critical statements about their own body weight, shape,
or size.
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Disordered eating thus spans a wide spectrum of maladaptive behaviors
and attitudes rooted in dissatisfied body image and unhealthy eating
habits. These attitudes and behaviors may not meet diagnostic criteria
for anorexia nervosa, bulimia nervosa, body dysmorphic disorder
(a disorder characterized by severe hatred of one’s body),
or eating disorder not otherwise specified (EDNOS), but they may
adversely affect health. Disordered eating may be encouraged by
athletic coaches advocating bodybuilding and weight control (up
to 62% of female and 33% of male athletes engage
in disordered eating, according to the National Athletic Trainers
Association) or by parents who themselves have disordered eating
and overemphasize thinness. Pediatricians encouraging weight loss
may unintentionally be supporting disordered eating habits.
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Disordered eating, especially binge eating, occurs prominently
in one third to one half of adolescent obesity cases. Seventy-nine
percent of overweight adolescents admit to unhealthy weight control
behaviors, and 17% admit to severe behaviors such as extreme fasting,
use of diet pills, and/or purging.1
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Adolescents with disordered eating are at higher risk for growth,
hearing, sleep, and headache problems and are more likely to report
depressive symptoms, including suicide ideation, poor body image,
and low self-esteem. Boys with disordered eating report higher incidences
of physical and sexual abuse than their peers, and girls with disordered
eating are more likely report histories of molestation and to engage
in risky sexual behaviors and substance abuse.2 Early
detection and treatment is vital to prevent the harmful effects
of disordered eating as well as to prevent their escalation into
full-blown eating disorders. Recognizable signs of disordered eating almost
always precede diagnoses of anorexia and bulimia nervosa. Early
detection may be hindered by infrequent visits to a pediatrician, too
little time during visits to obtain a thorough history, and reluctance
by pediatricians to intervene if a child does ...